Colorado’s Tragic Trifecta Of Funds Putting Residents At Risk For HIV and AIDS

Colorado’s Tragic Trifecta Of Funds Putting Residents At Risk For HIV and AIDS

Colorado HIV prevention funding cut after it was discovered the state health department had mismanaged a grant, leading to the $8 million refund in HIV and AIDS money.

This, in spite of the dramatic increase in the number of residents diagnosed with HIV – women especially.

According to the Colorado Health Department, 455 people will be told they have HIV before the end of 2019… an increase of nearly 40 people. The news comes after the 10+ years of promises in HIV prevention that includes a brand new drug that is going to change public health.

Throughout Colorado, clinics offer HIV testing and PrEP, a daily preventative pill, but are now seeing their budgets cut with no notice whatsoever.

The Colorado Department of Public Health and Environment reached out to clinics and other agencies, letting them know about the cut in funding from 25 percent, starting in January. This ignited a clash between a community group that has counseled the state about AIDS and HIV and state officials.

There are three reasons why the cuts are happening:

  • Multitude of grants are expiring
  • Legal view on how dollars should be spent
  • Previous mismanagement of federal dollars (which led to $8 million being returned to the government)

In 2017, the U.S. Health Services and Resources Administration awarded the state with $13.1 million under its Ryan White program, which is developed to help people who have HIV and AIDS. However, due to not spending the minimum 75 percent of the fund, Colorado officials had to return $7.9 million over the last four years.

  • 2015 - $757,000
  • 2016 - $4.3 million
  • 2017 - $2.5 million
  • 2018 - $357,000

HIV alliance members say the waste of funds is reckless, even more so now, because clinics are being hit hard even though they are trying to stem the HIV spread. It’s unclear if the cuts will impact care or mean a loss of jobs.

The state health department said there are over 14,000 Colorado residents who have HIV.

Barb Cardell was diagnosed with HIV in 1991 and is a current Colorado Alliance for HIV Prevention, Care and Treatment member. The alliance has had a positive standing with Colorado public health officials until recently. The alliance has been asking for some transparency in how the state is spending its money and an answer as to why money given to HIV and AIDS work is being sent back to the federal government.

As community members and activists, Cardell said, it’s concerning that the illogical activities are going to have a negative impact on people who have HIV or those at risk of acquiring it.

Besides the federal money going back, the Colorado Attorney General’s Office informed the health department back in September that it was no longer allowed to use supplemental rebate dollars for any HIV prevention. Rather, this money under the same rules applied under the Ryan White program – for people who already have HIV or AIDS. It does not go for the prevention of it.

Ryan White is the Indiana body who attained AIDS in 1984 after getting a blood transfusion. He died in April 1990 from pneumonia.

Colorado was using the rebate money to help with prevention, but state officials have designated it only for treatment.

And still, it gets worse, the four-year, $1 million a year-grant given from the U.S. Centers for Disease Control and Prevention is also ending.

CDPHE Executive Director Jill Hunsaker Ryan said she asked the staff to look over the financial controls to ensure the state was following the grant rules and ensuring contracts were released to community agencies to offer an array of services in a timely manner.

She said she wanted to make sure the money wasn’t being reverted, remarking about the previous accounting failures several years ago and before her appointment. She said she was looking into other funds the department could use to help with HIV prevention until a more sustainable funding source could be found.

Ryan said clinic support comes from various sources such as grants with different timeframes and pharmaceutical rebates.

Based on the advice Colorado officials had on the Ryan White program – to not spend money on HIV and AIDS prevention – Ryan said the topic is not closed. She said many other states are using the funds to pay for the PrEP drugs in at-risk HIV communities. Ryan said it was something she’d like looking more into, but the more discretion these programs have for the money, the easier it’ll be for the agencies to address community needs.

In 2012, the everyday antiviral, which sells under Truvada, became available. And, without any insurance, the drug can cost nearly $2,000 a month. When Congress wrote the Ryan White program rules, the drug hadn’t even been introduced, which is why many think it’s time for the law to be updated.

Ryan said preventing HIV is one of the state health department’s most crucial priorities. She said it is imperative that prevention responses are kept up to ensure people don’t continue to get this disease.

Written by Mark Riegel, MD

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